The 2 reperfusion therapies of proven benefit for acute ischemic stroke, mechanical endovascular thrombectomy (EVT) and pharmacologic intravenous thrombolysis (IVT), have complementary advantages. EVT, which involves mechanical debulking, works well for accessible sizeable thrombi that occlude large cerebral vessels and are resistant to rapid thrombolytic dissolution. IVT, which involves chemical dissolution, works well for smaller thrombi that occlude medium and small cerebral vessels inaccessible or poorly accessible to endovascular technology. An open, important question has been whether the modest efficacy of IVT for large vessel occlusions is sufficient to make the strategy of initiating IVT prior to EVT more effective than pursuing EVT alone.
Saver JL, Adeoye O. Intravenous Thrombolysis Before Endovascular Thrombectomy for Acute Ischemic Stroke. JAMA. 2021;325(3):229–231. doi:10.1001/jama.2020.22388
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